Hospital surge capacity preparedness in disasters and emergencies: a systematic review.

BACKGROUND: Adequate and effective emergency preparedness for hospital surge capacity is a prerequisite to ensuring standard healthcare services for disaster victims. This study aimed to identify, review, and synthesize the preparedness activities for and the barriers to hospital surge capacity in disasters and emergencies. METHODS: We systematically searched seven databases (PubMed, MEDLINE, CINAHL, Scopus, Embase, Ovid, and PsycINFO). We included all English peer-reviewed studies published in January 2016 and July 2022 on surge capacity preparedness in hospital settings. Two independent researchers screened titles and abstracts, reviewed the full texts, and conducted data extractions using CADIMA software. We assessed the rigor of the included studies using the NIH quality assessment tools for quantitative studies, the Noyes et al. guidelines for qualitative studies, and the MMAT tool for mixed methods studies and summarized findings using the narrative synthesis method. We also used PRISMA reporting guidelines. RESULTS: From the 2560 studies identified, we finally include 13 peer-reviewed studies: 10 quantitative, one qualitative, and two mixed methods. Five studies were done in the USA, three in Iran (n = 3), and the remaining in Australia, Pakistan, Sweden, Taiwan, and Tanzania. The study identified various ways to increase hospital surge capacity preparedness in all four domains (staff, stuff, space, and system); among them, the use of the Hospital Medical Surge Preparedness Index and the Surge Simulation Tool for surge planning was noteworthy. Moreover, nine studies (69%) recognized several barriers to hospital surge capacity preparedness. CONCLUSION: The review provides synthesized evidence of contemporary literature on strategies for and barriers to hospital surge capacity preparedness. Despite the risk of selection bias due to the omission of gray literature, the study findings could help hospital authorities, public health workers, and policymakers to develop effective plans and programs for improving hospital surge capacity preparedness with actions, such as enhancing coordination, new or adapted flows of patients, disaster planning implementation, or the development of specific tools for surge capacity. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022360332.

Aplicabilidad de los sistemas de triaje prehospitalarios en los incidentes de múltiples víctimas: de la teoría a la práctica / From theory to practice in the applicability of prehospital multiple-casualty incident triage systems: a systematic review

En los incidentes de múltiples víctimas (IMV), el triaje determina en gran medida los resultados finales en cuanto a asistencia sanitaria, organización y disminución de la morbimortalidad. La doctrina asistencial recomienda la realización del triaje ya en el ámbito prehospitalario para organizar la asistencia y evacuación de los heridos. Analizamos la aplicabilidad real de las recomendaciones en cuanto al triaje prehospitalario en IMV medianteuna revisión sistemática de la literatura científica utilizando como palabras clave "mass casualty triage" y "prehospital triaje". Se usan como fuentes de datos PubMed, Cochcran y las revistas EMERGENCIAS y Prehospital and Disaster Medicine. También se revisó la bibliografía de los artículos localizados. Se localizaron 561 artículos con los criterios de búsqueda, de los que 19 cumplían todos los criterios de inclusión. Es escasa la referencia que se hace a la metodología de triaje realizada, y en muchos de ellos se hace referencia explícita a la no realización del triaje. Existe una discrepancia entre la doctrina asistencial ante IMV y los datos publicados que puede ser debida a la dificultad de obtener datos en la escena del siniestro, a que las dificultades asistenciales no permiten aplicarla doctrina asistencial, o que ésta no es válida (AU)

Triage has a great effect on results in multiple-casualty incidents (MCIs), reducing morbidity and mortality through the allocation and organization of health care resources. Prehospital triage to organize care and evacuate casualties is a key theoretical premise in emergency health care. To analyze the applicability of prehospital triage recommendations for MCIs, we searched the literature using the search terms mass casualty triage and prehospital triage in the PubMed database, the Cochrane Library, and the journals Emergencias and Prehospital and Disaster Medicine. We also checked the reference lists of all articles found. Of a total of 561 titles located, 19 met the inclusion criteria. The articles offer little information on methods used for triage in MCIs and many explicitly state that no triage system was used. There is inconsistency between the theoretical approach to care applicable in MCIs and the reports of actual events, possibly because it is difficult to obtain data at the scene of the incident, because care giving interferes with the application of theory, or because the theory itself is invalid (AU)

Supervivencia de las paradas cardiacas extrahospitalarias atendidas por una unidad de vigilancia intensiva móvil de Asturias en 2010 / Survival of out-hospital cardiac arrests attended by a mobile intensive care unit in Asturias (Spain) in 2010

Objetivo Determinar los tiempos de asistencia, características extrahospitalarias e intrahospitalarias y supervivencia de las paradas cardiacas atendidas por una UVI móvil, al igual que los factores implicados en la supervivencia al ingreso y al alta hospitalaria. Diseño Estudio observacional retrospectivo desde el 1 de enero de 2010 al 31 de diciembre de 2010, con un seguimiento de un año desde la PCR. Ámbito Área sanitaria IV del Principado de Asturias, con 342.020 habitantes en 2010.PacientesSe incluyeron todos los pacientes que sufrieron una PCR en 2010 y fueron atendidos por la UVI móvil. Variables principales Datos demográficos, causa de la PCR, intervención por testigos, tiempos de asistencia y supervivencia al ingreso, al alta y un año después. Resultados Se atendieron un total de 177 paradas cardiacas. En 120 se indicó el soporte vital avanzado (SVA), siendo 66 de ellas (55%) de causa presumiblemente cardiaca. Recuperaron el pulso 63 pacientes (52,5%), llegando 51 de ellos con vida al hospital (42,5%). Se les dio el alta a 13 pacientes (10,8%). Al año 11 (9,2%) seguían vivos y 9 de ellos (7,5%) tenían una cerebral performance category (CPC) de 1. El ritmo inicial de fibrilación ventricular (FV) y los tiempos cortos en la asistencia se relacionaron con la supervivencia. Conclusiones La supervivencia fue superior a la publicada al ingreso al hospital y similar a la del alta. Como factores relacionados se encontraron los tiempos de asistencia y el ritmo inicial. La reanimación por el testigo fue escasa y no se usaron desfibriladores semiautomáticos (DEA) públicos (AU)

Objective To evaluate attendance timings, out- and in-hospital characteristics, and survival of cardiac arrests attended by an advanced life support unit in Asturias (Spain) in 2010. Factors related to survival upon admission and at discharge were also analyzed. Design A retrospective, observational trial was carried out involving a cohort of out-hospital cardiac arrests (OHCA) occurring between 1 January 2010 and 31 December 2010, with one year of follow-up from OHCA. Setting Health Care Area IV of the Principality of Asturias, with a population of 342,020 in 2010.PatientsAll patients with OHCA and attended by an advanced life support unit were considered. Main variables Demographic data, the etiology of cardiac arrest, bystander cardiopulmonary resuscitation (CPR), attendance timings and survival upon admission, at discharge and after one year. Results A total of 177 OHCA were included. Of these, 120 underwent CPR by the advanced life support team. Sixty-six of these cases (55%) were caused by presumed heart disease. A total of 63 patients (52.5%) recovered spontaneous circulation, and 51 (42.5%) maintained circulation upon admission to hospital. Thirteen patients (10.8%) were discharged alive. After one year, 11 patients were still alive (9.2%) - 9 of them (7.5%) with a Cerebral Performance Category (CPC) score of 1. Ventricular fibrillation and short attendance timings were related to increased survival. Conclusions The survival rate upon admission was better than in other series and similar at discharge. Initial rhythm and attendance timings were related. Public automated external defibrillators (AED) were not used, and bystander CPR was infrequent (AU)

[Survival of out-hospital cardiac arrests attended by a mobile intensive care unit in Asturias (Spain) in 2010]. / Supervivencia de las paradas cardiacas extrahospitalarias atendidas por una unidad de vigilancia intensiva móvil de Asturias en 2010.

OBJECTIVE: To evaluate attendance timings, out- and in-hospital characteristics, and survival of cardiac arrests attended by an advanced life support unit in Asturias (Spain) in 2010. Factors related to survival upon admission and at discharge were also analyzed. DESIGN: A retrospective, observational trial was carried out involving a cohort of out-hospital cardiac arrests (OHCA) occurring between 1 January 2010 and 31 December 2010, with one year of follow-up from OHCA. SETTING: Health Care Area IV of the Principality of Asturias, with a population of 342,020 in 2010. PATIENTS: All patients with OHCA and attended by an advanced life support unit were considered. MAIN VARIABLES: Demographic data, the etiology of cardiac arrest, bystander cardiopulmonary resuscitation (CPR), attendance timings and survival upon admission, at discharge and after one year. RESULTS: A total of 177 OHCA were included. Of these, 120 underwent CPR by the advanced life support team. Sixty-six of these cases (55%) were caused by presumed heart disease. A total of 63 patients (52.5%) recovered spontaneous circulation, and 51 (42.5%) maintained circulation upon admission to hospital. Thirteen patients (10.8%) were discharged alive. After one year, 11 patients were still alive (9.2%) - 9 of them (7.5%) with a Cerebral Performance Category (CPC) score of 1. Ventricular fibrillation and short attendance timings were related to increased survival. CONCLUSIONS: The survival rate upon admission was better than in other series and similar at discharge. Initial rhythm and attendance timings were related. Public automated external defibrillators (AED) were not used, and bystander CPR was infrequent.

Sistema sanitario y triaje ante una pandemia de gripe: un enfoque desde la salud pública / Triage in the health care system during an influenza pandemic: a public health perspective

La actual situación de pandemia gripal a la que se enfrenta nuestro sistema sanitario supone todo un reto que debe de ser gestionado de una manera integral por parte de los responsables sanitarios. Debido a una más que probable saturación del sistema sanitarioa todos los niveles, es necesario instaurar protocolos de triaje coordinados entrelos distintos niveles asistenciales. En este artículo se presenta como novedad el importante papel que puede tener el triaje como una herramienta al servicio de los profesionales sanitarios para gestionar los flujos de pacientes que se producirán debido a la pandemia gripal, sin entrar a analizar los distintos protocolos de triaje que ya se manejana nivel internacional. En definitiva, se da al triaje una importancia relevante en cuanto a su papel como herramienta clínica al servicio de la salud pública (AU)

The current influenza pandemic confronting our health care system is a challenge for the responsible authorities to manage with an integrated, system-wide approach. As the entire health care system is likely to become overburdened, referrals between different levels of care should be coordinated, guided by the use of triage protocols. This paper discusses the new and important role of triage as a tool for managing patient flow during an influenza pandemic, although the specifics of the various protocols already in use internationally are not analyzed in detail. Certainly, triage is a key clinical tool at the service of public health (AU)

Dossier de inteligencia sanitaria / No disponible

No disponible

[Risk of chemical disaster as a public health problem]. / El riesgo de desastre químico como cuestión de salud pública.

This revision is aimed at providing health care personnel, particularly those who may be involved in planning and/or responding to a chemical accident, with an overview of the subject of major industrial accidents. In the introduction, a brief presentation is made of some data concerning the main industrial disasters which have occurred in the past in addition to some accidents which have occurred in our area that could have evolved into a major accident. A review is also provided of Spanish and European laws currently in effect regarding this matter, in addition to summarizing the main consequences which may result from explosions, phenomena of a thermal type and the leakage of hazardous substances, particularly stressing the third of these three cases. A brief summary is also given of the main steps to be taken for a correct risk analysis in a given geographical area. Lastly, the overall organization of the Chemical Industry Emergency Plans and the functions of the different groups taking part therein, including the main functions of the medical team, is provided. Planning and responding to an industrial disaster is markedly multi-disciplinary endeavor, and this document is aimed at providing health care professionals with an overview of the main aspects involved in order to thus contribute to a more in-depth knowledge of a subject which we consider to be of importance for health care personnel and a better-integrated response, given that were an industrial disaster to occur, we would have to deal with a serious public health care problem on the spot.